"The policies in the final rule will further advance the agency’s commitment to ensure patients have the information they need to make well-informed healthcare decisions by requiring the disclosure of actual prices and ensure pricing information is easily comparable across hospitals. This fact sheet discusses the hospital price transparency final provisions of the calendar year 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center final rule."  MORE >>

"Key 2026 changes to machine-readable files (MRFs) include replacing estimated allowed amounts as the listed element when payer-specific negotiated charges are expressed as a percentage or an algorithm. Instead, the hospital must convey the median allowed amount and the 10th and 90th percentile allowed amounts. The rule thus phases out estimated allowed amounts only one year after CMS added them as an MRF component."  MORE >>

"As shortages resolved, many clinics, compounding pharmacies and online peptide sellers continued practices that had developed during a period of unusual market pressure. State attorneys general have stepped into the gap, using consumer-protection theories to police misrepresentations, dangerous sourcing practices and improper use of research-grade materials. The FDA is now being asked to join that response."  MORE >>

"The state of Colorado ... has placed a price limit on the prescription drug Embrel from Immunex Corp. ... The Colorado Consumer Health Initiative estimates that the price cap could save consumers $32 million in drug spending. About 60% of the 2,500 individuals in Colorado who take Enbrel have private insurance. Before the price cap, patients paid about $4,000 of the annual $58,000 cost of the drug. Now, the price of Embrel is capped at about $31,000 per year, and patients have a payment of about $600."  MORE >>

"In litigation under the No Surprises Act (NSA), a district court rejected a health provider's argument that an independent dispute resolution (IDR) determination involving a surprise medical billing claim under the NSA was enforceable under the Federal Arbitration Act (FAA). The court also found that the NSA did not create a private cause of action for judicial confirmation of IDR awards." [Freeman Pain Inst. v. Horizon Blue Cross Blue Shield of N.J., No. 25-2507(D.N.J. Nov. 24, 2025)]  MORE >>

"This report ... reviews and analyzes data made publicly available ... regarding IDR operations in calendar year 2024.... [T]he data show an IDR process that was still maturing in 2024, as the year saw significant increases in the use of the IDR process by providers; a large increase in the number of determinations made relative to 2023 and improvements in the amount of OON emergency/nonemergency service dispute determinations made within the generally required 33 business days; and continued notable increases in payment determination amounts in certain medical specialties." [R48738 Nov. 26, 2025]  MORE >>

"Whereas HIPAA only covers healthcare providers, payers and clearinghouses and their business associates that electronically transmit data, Cassidy's HIPRA [S 3097] would address the growing number of consumer apps, wellness platforms and wearables that collect consumer health data such as weight, blood pressure readings, sexual health information or other sensitive health information."  MORE >>

"As employers brace for rising healthcare prices next year, many are finding that better investments in behavioral health could be one of the most effective ways to curb costs.... [E]mployers risk further increasing their healthcare spending in the long-run if they don't invest in preventive services and other more acute needs, as untreated substance use disorders often lead to repeated emergency visits, costly complications and more intensive medical care down the line."  MORE >>

"A SAR is a summary annual report, and its purpose is to summarize for employees the information that appears in an ERISA plan's Form 5500. SARs are required each year for pension plans, including 401(k) plans, and for welfare plans unless an exemption applies.... The SAR must be furnished to participants covered under the plan and to other individuals who must be provided with summary plan descriptions (SPDs), such as COBRA qualified beneficiaries. SARs may be distributed by any method permissible for SPDs, including electronically."  MORE >>